NPIMap

Organization Active NPI

Qam

Doing business as Racine Comprehensive Treatment Center

  • Addiction (Substance Use Disorder) Counselor
  • Racine, WI
National Provider Identifier
1457807091
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
15532-132 Issued in WI
Legal business name
QAM
Doing business as
Racine Comprehensive Treatment Center
Practice address
5735 Durand Ave
A
Racine, WI 53406-5011
Phone
(262) 598-1392
Fax
(262) 598-1395
NPI assigned
Sep 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kim Mason
Title
Clinic Director
Phone
(262) 598-1392

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X 15532-132 WI Primary

Addresses

Primary practice location

5735 Durand Ave
A
Racine, WI 53406-5011

Mailing address

5735 Durand Ave
A
Racine, WI 53406-5011
Phone (262) 598-1392

Other names 1

  • Racine Comprehensive Treatment Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Professional Rec Net SC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5735 Durand Ave
#A
Mount Pleasant, WI 53406
Phone (262) 598-1392

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1457807091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5735 DURAND AVE",
            "address_2": "A",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534065011",
            "telephone_number": "262-598-1392",
            "fax_number": "262-598-1395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5735 DURAND AVE",
            "address_2": "A",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534065011",
            "telephone_number": "262-598-1392",
            "fax_number": "262-598-1395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "262-598-1392"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15532-132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Racine Comprehensive Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.